Blog: National Partnership for Action

Defining Health Equity in Neighborhood Design

How do we create interventions that can encourage all members of society to be more physically active and eat better diets? It’s a knotty question with many different factors to be considered. One basic element is where the interventions are. We’re pretty sure that good neighborhood design, with well-located resources, can reduce health disparities associated with poverty. However, an intervention is less likely to improve minority health if it’s not accessible to those most in need. I investigated this using the English ‘Healthy Towns’ communities, a group of ethnically diverse towns and cities, including neighborhoods in London, experiencing poverty and ill health. The government had funded health promoting infrastructure in these places. I tested a
technique for spatial equity analysis to help us understand what infrastructure was put where, for whom and why.

This technique can be used to identify resource gaps and suggest locations where interventions should be located to address health disparities. The process is relatively straightforward, but you need to be thorough when collecting your evidence. It’s not just a case of drawing, say, a one mile circle around existing play parks and claiming that children living in these areas are well-provided for and those outside aren’t. For example, some locations have more children living there, therefore a higher demand. Or, parks may be plentiful but underused because of their poor quality or poor access. These considerations are crucial for directing infrastructure and other interventions to where they’re needed most.

Lessons learned:

Identify what infrastructure exists and where. Policymakers, managers, local authorities, voluntary groups and other organizations all have information and perspectives. But beware; making an inventory of everything that actually exists is time consuming!

You need to act fast to gather the information. Policy, people and funding are all constantly changing: the people with the knowledge you need may not be in post for long.

Not everyone has equal access to or need for resources. Just because there’s an area where a certain type of infrastructure doesn’t exist, doesn’t mean it is needed. Assess which population groups have particular unfulfilled needs.

Taking a geographical view of things is crucial. Physical interventions are located in space, as are people and the journeys they take to access resources. Understanding how people use environments where they live and work should inform where we locate interventions.

Quality vs. quantity. The quality of a resource may influence somebody’s likelihood of using it: better to have one playground visited by many children than three dilapidated ones that are never used. Factor this into an assessment of resource availability.

Overall, this work indicated that spatial equity analysis can be useful as the first step in future evaluations for health interventions, especially when it’s too early to measure direct health impacts. In the case of the ‘Healthy Towns’ program, we found that interventions were generally well-located in areas of highest population need, as determined by program managers. This is a good start, but we’ll need to wait to see if the aims – to make people more active and healthier eaters – will be met.

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About the Blog

The NPA works to achieve health equity -- the highest level of health for all people. This blog is a venue for professionals from all fields and sectors to share their thoughts on pressing issues, news and events pertaining to health equity. Follow and participate in this candid discussion.

About the Author

Alice Dalton is a Senior Research Associate with the
University of East Anglia (Norwich, UK). She uses GIS and GPS to understand
the health implications of human interactions with natural and built environments.
She works with researchers at the UKCRC Centre for Diet and Activity Research (CEDAR) .